Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6032 | IA |
NPI | 1033293469 |
---|---|
Provider Name | Dr. Edward B. Murray JR. |
First Address | Council Bluffs, IA 51503-1622 |
Second Address | Council Bluffs, IA 51503-1622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6032 | STATE DENTAL LICENSE (01) | IA |